Date of Award

8-2020

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Suzanne G. Leveille

Second Advisor

Janice B. Foust

Third Advisor

Ling Shi

Abstract

Persistent multisite pain is highly prevalent, affecting 25-43% of community-dwelling older adults. Although existing evidence suggests that persistent multisite pain is associated with physical and psychological disability, studies use a cross-sectional assessment approach that overlooks pain duration or persistence. This study aimed to estimate the persistence of multisite pain and the proportion of incident multisite pain and examine the association between persistent multisite pain and physical (ADL and IADL) and psychological disability (depression and anxiety) at 18 months and six years. Also, the association between baseline persistent multisite pain and mortality was assessed.

Secondary data analysis of the MOBILIZE Boston Study (MBS) was performed using data from baseline, 18 months, and six years. Pain distribution assessed longitudinally at three-time points were categorized as no pain, single-site pain, incident multisite pain, and persistent multisite pain. Chi-square analysis, ANOVA tests, and several multivariable regression models were employed.

The prevalence of persistent multisite pain was 26% and 27%, and incident multisite pain was 10% and 18% at 18 months and six years, respectively. For individuals with incident multisite pain, the risk for ADL difficulty became evident only at six years, but individuals with persistent multisite pain consistently had a much higher risk for ADL difficulty at 18 months and six years. There is a substantial increase in the risk for a lot of IADL difficulty in individuals with incident or persistent multisite pain compared to individuals with no pain. Incident multisite pain was not associated with depression and anxiety at six years, while persistent multisite pain was associated with psychological disability at 18 months and six years. Essentially, persistent multisite pain is more debilitating than incident multisite pain. There was no association between persistent multisite pain and mortality at 12.4 years.

This study's findings contribute to geriatric pain research by revealing the disabling consequences of the persistence of multisite pain. Proper utilization of multisite pain measures and assessment of the functional capacity is crucial when evaluating elders with multisite pain. Importantly, clinicians need to be aware of depression and anxiety when treating the elderly with multisite pain.

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